Hippocampal dysfunction in cured Cushing's syndrome patients, detected by H-1-MR-spectroscopy
Por:
Resmini, E, Santos, A, Gomez-Anson, B, Lopez-Mourelo, O, Pires, P, Vives-Gilabert, Y, Crespo, I, Portella, MJ, de Juan-Delago, M, Webb, SM
Publicada:
1 nov 2013
Resumen:
BackgroundProton magnetic resonance spectroscopy (H-1-MRS) is a sensitive, noninvasive imaging technique capable of measuring brain metabolites in vivo. Chronic exposure to endogenous hypercortisolism in Cushing's syndrome (CS) is associated with negative effects on memory and hippocampal volumes, even after biochemical cure.
ObjectiveTo investigate metabolites in the hippocampi of CS patients and controls, using H-1-MRS.
Patients and methodsEighteen right-handed cured CS patients (age 448125years, 12638years of education) and 18 right-handed healthy controls, matched for age (400 +/- 119) and years of education (144 +/- 38), underwent 3-Tesla magnetic resonance imaging (3T MRI) and H-1-MRS including the head of each hippocampus. Concentrations of Glu (Glutamate), Glx (Glutamate+Glutamine), NAA (N-Acetyl-aspartate), total NAA (N-Acetyl-aspartate+N-Acetyl-aspartyl-Glutamate), Cho (Glycerophosphocholine and Phosphocholine compounds), Cr (Creatine) and MI (mionositol) were measured (mmol/l). Hippocampal volumes (mm(3)) were additionally calculated using an automated procedure (FreeSurfer).
ResultsCS patients had lower NAA than controls in the left and right hippocampus (52 +/- 10 vs 61 +/- 07, P<005; 49 +/- 08 vs 61 +/- 06, P<0001, respectively), and lower total NAA on the right side (57 +/- 09 vs 63 +/- 09, P<005), suggesting neuronal dysfunction/loss. CS patients had higher Glx than controls in both hippocampi (104 +/- 19 vs 86 +/- 14, P<001; 99 +/- 16 vs 89 +/- 13, P<005, respectively), suggesting glial proliferation, as a repair mechanism after neuronal dysfunction. No differences were found in the other brain metabolites, and there were no differences in left (381578 +/- 50296) and right (398075 +/- 36944) total hippocampal volumes between CS patients and controls (394508 +/- 40890 and 410839 +/- 36511, respectively).
ConclusionPersistently abnormal metabolites are evidenced in the hippocampi of CS patients despite endocrine cure. These functional alterations could be early markers of glucocorticoid neurotoxicity, preceding hippocampal volume reduction.
Filiaciones:
Resmini, E:
ISCIII, IIB St Pau, Hosp St Pau, Endocrinol Med Dept,CIBER ER,Unidad 747, Barcelona, Spain
Univ Autonoma Barcelona, E-08193 Barcelona, Spain
Santos, A:
ISCIII, IIB St Pau, Hosp St Pau, Endocrinol Med Dept,CIBER ER,Unidad 747, Barcelona, Spain
Univ Autonoma Barcelona, E-08193 Barcelona, Spain
Gomez-Anson, B:
Hosp Santa Creu & Sant Pau, Neuroradiol Unit, Barcelona 08025, Spain
UAB, IIB St Pau, Barcelona, Spain
Lopez-Mourelo, O:
PIC, Bellaterra, Spain
UAB, IFAE, Bellaterra, Spain
Pires, P:
PIC, Bellaterra, Spain
UAB, IFAE, Bellaterra, Spain
Vives-Gilabert, Y:
PIC, Bellaterra, Spain
UAB, IFAE, Bellaterra, Spain
Crespo, I:
ISCIII, IIB St Pau, Hosp St Pau, Endocrinol Med Dept,CIBER ER,Unidad 747, Barcelona, Spain
Univ Autonoma Barcelona, E-08193 Barcelona, Spain
Portella, MJ:
UAB, Hosp St Pau, Dept Psychiat, Barcelona, Spain
de Juan-Delago, M:
Hosp Santa Creu & Sant Pau, Neuroradiol Unit, Barcelona 08025, Spain
UAB, IIB St Pau, Barcelona, Spain
Webb, SM:
ISCIII, IIB St Pau, Hosp St Pau, Endocrinol Med Dept,CIBER ER,Unidad 747, Barcelona, Spain
Univ Autonoma Barcelona, E-08193 Barcelona, Spain
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